What Indian hospitals should do to minimise the risk of virus propagation

Examples of Wuhan Hospital, China and St Francis Hospital in Marange-Silvange in northeastern France explain how these hospitals managed to reduce virus propagation risk within their hospitals using simulation technology on an open community platforms

The COVID-19 pandemic has really got the world more closer, as the global scientific communities, industries, researchers and governments, all work in tandem to find solutions to this great crisis. Digital technologies and open-source platforms are been extensively utilised for leveraging collective intelligence, knowledge exchange and continuous learning within various scientific communities. With the help of one such open-source platform, hospitals from countries like China and France have been able to alter infrastructure and control air pressure using simulation to optimise the layout of HVAC design within their hospitals to contain the virus spread. Now, simulation is a technology that is widely used in aerospace and automotive industries, but its applicability in healthcare has been a revelation to many.

Here are two examples of Wuhan Hospital, China and St Francis Hospital in Marange-Silvange in northeastern France that explain how these hospitals managed to reduce virus propagation risk within their hospitals using simulation technology on an open community platform.

The need and the execution plan

In December 2019, when the coronavirus outbreak first broke out in Wuhan city, the Wuhan Hospital had to immediately convert certain hospital wards and departments suitable for isolation and appropriate patient care. While trying to find ways by which they could turnaround their infrastructure and ensure safety, some of the researchers from the hospital sorted answer from the open COVID-19 community online. 3DEXPERIENCE Lab, an open-source community by Dassault Systèmes offered to help. Similarly, when the pandemic spread to France, the St Francis hospital needed to convert a floor into an area to accommodate COVID-19 patients and wanted to reduce the risk of virus propagation inside. Here is when Dassault Systèmes stepped in with its simulation applications.

Explaining further, Frederic Vacher, Head of Innovation, 3DEXPERIENCE Lab, Dassault Systèmes, said, “We helped run iterations of an airflow across different options for hospital managers to optimise interiors so that they could be ready to serve COVID patients. Results were immediate as the simulation shows most of the particles were propagating in the corridors and close to the coffee machine, this was not obvious for the healthcare workers, they had to change those locations simulation was showing also.”

Based on a floor plan in 2D, 3D modelling, it was possible to reassemble the partitions and the walls of the area concerned to quickly provide an idea of the hospital’s current layout. Dassault Systèmes team of scientists and analysts then used SIMULIA computational fluid dynamics simulation applications to simulate different airflow fields within the building, enabling hospital directors to understand how the corridors were important vectors of propagation and optimise the interior layout.

The team made assumptions about patient behaviour, the impacts of a cough, and the floor’s ventilation and air conditioning systems, including air leaks in the windows and doors. They studied different options by simulating reduced ventilation as well as the strategic opening of windows, to understand the impact of fresh air on airflow and the concentration of virus particles. Throughout the project, engineers provided support and mentoring and the medical community provided feedback. Hospital technicians also tested with sensor equipment from local industrial companies to validate the different simulations.

Adding more, Vacher goes on “In the past, for hospital design, the simulation was rarely leveraged, and never used for airflow simulation. Those types of the simulation were mostly used in aerospace or automotive industries. Most probably hospital engineering or re-engineering will now be considered at the time of virus propagations risk. This will not only help to protect healthcare workers and patients, but also optimise the processes, the interior design, and even energy efficiency.”

But wait, this wasn’t as simple as may come across. There are some risk factors that hospitals may face while converting certain areas into COVID-19 wards. And that’s what Shen ZHANG, Director, Engineering Digital Technology Center of Central-South Architectural Design Institute (CSADI), Greater China expounds about.

Overcoming risk

“Until the COVID-19 outbreak, hospitals usually carried out air distribution design based on relevant design standards. The standard specifications are usually just some general principle requirements and empirical formulas for air distribution designs, which have not been validated and optimised by fire department simulations. XFLOW can compare multiple designs to find the one with minimum contaminant diffusion, eliminating incidents with the unnecessary cross-infection of physicians due to improperly designed HVAC, which brings risks to the health and safety of medical staff”, Zhang mentions. So, while implementing this process, both the Wuhan Hospital and St Francis Hospital had to comply with some pre-requisites to avoid major mistakes. Zhang adds, “Such ad hoc setups mainly consist of negative pressure isolation rooms, which require artificially directed airflows towards clean zones, semi-contaminated zones and contaminated zones, and require a minimum of two air changes per hour, and each room must have its own contained AC module to prevent cross-contamination. Compared to the contaminated zones, the staff area should be a positive pressure area to prevent contagions from spreading and ensure the health and safety of medical staff.”

Furthermore, Zhang explains that the medical outcomes from such endeavours, although may be difficult to account, but these are critical measures that hospitals need to consider. “Due to the needs of medical staff to enter and exit wards and transferring patients, it is unrealistic to assume 100 per cent air isolation between isolation rooms and other areas of the ward. So, it is particularly important to use simulation to optimise the layout of HVAC design. The simulation analysis of indoor contaminant concentration and outdoor contaminant diffusion can be carried out with the help of the simulation software XFLOW by Dassault Systèmes. It can better optimise the HVAC system design, including the filter location and the number of contaminant particles emitted by hospitals, reduce the risk of cross-infection and ensure the safety of medical staff and surrounding residents,” he sums up.

Learnings for India

The above examples ensure one key learning for us and the need for collective intelligence for critical solutions during such crisis. Just as Indian hospitals continue to grapple with the increasing burden of the COVID-19 pandemic, there are many concerns related to the risk of virus propagation. Many hospitals still do not even understand the significance of air pressure controls and risk of infection spread through HVAC systems. In such circumstances, India too needs the scientific community to gather knowledge and connect with solution providers from across the world to find critical solutions and strategies.

Nevertheless, India isn’t far behind. As soon as the virus took precedence in Kerala, the state launched the CoronaSafe Network. This was launched with the intention to combat the spread of the virus and to prepare the state to face the untoward situation. Now, CoronaSafe Network is an open-source public utility designed by a multi-disciplinary team of innovators and volunteers who are working on a model to support government efforts with full understanding and support of the Government of Kerala. The entire premise of CoronaSafe Network has been based on single well-coordinated ‘war strategy’ that includes Central and state governments, administrative officers, defence personnel, hospital administrators, doctors, software programmers, educational institution administrators, students across any discipline of any age group, general public and volunteers from the state of Kerala and outside Kerala.

As per the Kerala government, once the initiative attains the success it desires, the system can be replicated in other states too. While epidemiologist is still evaluating its success and outcomes, such examples certainly teach us the value of collaborative thinking.